“Closely allied to, and in some cases almost inseparable from,
hysterical states are those morbid conditions to which, in modern
times, has been applied the term neurasthenia.” (Yeo). Neurasthenia
is a fatigue neurosis that is characterized by mental and physical
irritability and inefficiency. Headache, backache, insomnia, and
debility of the gastro-intestinal tract are common symptoms.
The affection is often found in that class of people who are
predisposed to hysteria. The disease is more common among men than
women, usually occurring after the twentieth year. The predisposition
may be inherited or acquired. Church states that “debilitating
conditions in the antecedents of neurasthenics,” and “defective
education that omits discipline and the cultivation of self control”
are important predisposing causes. Many of the exciting causes that
produce hysteria will cause neurasthenia. Various =lesions= along
the spinal column, chiefly in the cervical and upper dorsal regions,
include the predisposing causes of a large majority of cases. This
spinal irritation, taken in conjunction with overstrain of mind
and body, or probably in many cases the spinal irritation as the
predisposing cause of the over strain, results in nervous exhaustion.
Particularly overwork, associated with care and anxiety, is an exciting
cause of great significance.
The neurasthenic patient is generally of a =neurotic temperament=.
The affection may, also, result from various chronic diseases, toxic
conditions, sexual excesses, alcohol and tobacco. Thompson[124]
believes that improper sexual hygiene and perversion or abuse of the
marital relation are most important factors in the development of
neurasthenia in both sexes, and a regulation of this is imperative
for a cure. The symptoms are due, to a greater or less extent, upon
=spinal=, =cerebral=, =cardiac= and =gastric disturbances=, but all
of these conditions are usually dependent upon =vertebral= and =rib
lesions= of the upper dorsal and cervical regions. Care should be taken
whether the condition is secondary to organic lesions. The lesions
in the vertebræ are generally slight lateral deviations, in the ribs
upward displacements of the vertebral ends, followed by contraction
of the deep muscles in the neighborhood of the lesions. A posterior
condition of the atlas and a lateral lesion between the third and
fourth dorsal are especially apt to be found. As to spinal areas most
affected Stearns[125] says the predisposing irritations are located
particularly in the first two cervical, the first two dorsal and the
last two lumbar vertebræ.
These various lesions probably cause an impairment of nutrition in
the nerve centers of the cord and brain, or both. Definite =morbid
anatomical= changes have not been found resulting from nervous debility
or irritability. Still, it seems probable that certain changes in the
nerve cells may result from excessive functional activity. =Traumatism=
is a prominent causative factor in both =neurasthenia= and =hysteria=.
=Railway= and other =injuries= frequently produce osteopathic lesions
that result in nervous disorders. That there is a demonstrable
pathological basis resting in sympathetics and spinal nerves, there can
be no doubt.
=Symptoms.=—To enumerate the many symptoms of neurasthenia in detail
is hardly necessary. The nervous debility may affect any organ of the
body, owing to the exhaustion of the nervous energy, thus lessening the
functional activity of that organ.
The most noticeable symptoms are various =sensory disturbances= and
=muscular weakness=, dependent in part upon the spinal lesions. The
patient generally feels weak and tired. Headache, pains in the back
and sacrum, tender points along the spine, and various sensations of
numbness, tingling, etc., are felt.
The =mental faculties= are oftentimes irritable and weak. An inability
to concentrate the thoughts with depression, fear, vertigo, insomnia,
and many other mental symptoms, may be manifested.
=Palpitation=, irregular action of the heart and pain over the
precordia may be present. =Ocular= disturbances, particularly blurring
of letters and narrowing of the visual field, =visceral= symptoms
of many kinds, and =vasomotor= phenomena, as chilliness, flashes of
heat and sweating, are among the many symptoms of which the patient
complains.
=Genito-urinary= disorders in the male, and ovarian and uterine
irritation and painful menstruation in the female, are occasionally
symptoms dreaded by the sufferer. Polyuria is frequent.
The symptoms or signs of great importance to the osteopath in
neurasthenia, as in many other diseases, are the tender points along
the spinal column. They give direct clues as to where the lesion may be
found.
=Diagnosis.=—Error in diagnosis can usually be prevented by a study of
the history of the case and symptoms. Care must be taken in determining
between symptoms of organic diseases and the symptoms of a true nervous
exhaustion.
=Prognosis.=—Is almost invariably good. Only in cases where there is
a tendency to mental disorder should the prognosis be guarded. Much
depends upon the thorough cooperation of the patient. It usually takes
some time to perform a cure among the poorer class, as the requirements
demanded for a cure are oftentimes expensive.
=Treatment.=—Naturally the treatment, exclusive of the manipulation to
correct the various lesions found, is extremely varied, owing to the
many exciting causes and symptoms to contend with.
As has been stated, the lesions are usually found in the upper spinal
region; still lesions are occasionally located in the lower spinal
region, especially in female sufferers, when the pelvic organs are
disturbed. The many mental symptoms, as inability to concentrate the
mind, insomnia, vertigo, headache, etc., are best treated through the
cervical region, with attention to the heart’s action and the excretory
organs. Careful attention should be paid to the deep posterior muscles
between the atlas and occipital bones.
=Rest= is very necessary. Changes of scene and occupation, attention to
the surroundings, careful dieting, hydrotherapeutic measures, pleasant
companions, relief from responsibility, bathing, etc., should receive
careful attention and consideration by the osteopath. Set rules cannot
be given. The details of treatment that should be adopted are dependent
upon the individual case. Every well trained osteopath will be familiar
with such measures.
Careful attention must be given to the secretions, excretory organs
and the circulation. A study of each case will bring out the various
irregularities that may exist.
When the nervous involvement is extensive, a “general treatment” may be
given. Such a treatment would affect the entire nervous and muscular
system, and tend to equalize disturbed nerve force. Bringing the
muscular system into play and relaxing contracted muscles calls for
more blood and nerve force, and consequently a nutritious diet.
The “rest cure,” as introduced by Weir Mitchell, may be employed to
considerable advantage in many cases. Yeo says: “It is in certain cases
of this disease that the ‘rest cure,’ devised by Weir Mitchell, has
proved so remarkably successful. But there can be no sort of doubt
that it has been applied far too indiscriminately, and that for this,
as indeed for any special method of treatment, a careful selection of
suitable cases is needful.” The diet should consist principally of milk
at first, followed in a few days by soft boiled eggs, boiled rice, lamb
chops, graham bread, stewed fruits and butter, and a little later by
roast beef, vegetables and light puddings. Porter’s system of milk diet
has proved effective in many cases. Tea, coffee and alcohol should be
avoided.
During the entire course of the treatment, care should be taken
to correct any lesion that may bear directly upon the cervical
sympathetic, the solar plexus and the hypogastric plexus, as they are
the great reflex centers of the body.